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2. It allows bilateral cortical stimulation and, residual hearing and good performance with the HA
in children, the development of the central in the non-implanted ear.
auditory system during the critical period of Bimodal stimulation can offer additional advan-
neural plasticity and language acquisition. tages in terms of speech understanding in quiet and
3. It can restore binaural hearing. noise, and some degree of sound localization. The
advantages of bimodal stimulation are as follows:
The disadvantages are as follows:
1. It stimulates the non-implanted ear.
1. Procedure costs. Benefits of bilateral cortical 2. It provides binaural advantages in patients with
development when stimulating with bilateral residual hearing and good HA performance in
cochlear implants should be considered for the non-implanted ear.
quantifying the actual benefit in terms of cost- 3. It does not require surgery in one ear.
effectiveness. 4. It is cost-effective.
2. It may make future techniques difficult or
impossible to use. The disadvantages of bimodal stimulation are as
follows:
Bilateral cochlear implantation should be recom-
mended in the following types of patient: 1. Obtaining a binaural advantage depends on the
residual hearing and HA performance in the
1. Those in whom the benefits obtained with one
non-implanted ear. In young children it is
CI is poor.
difficult to determine the hearing status of the
2. In Meningitis, that is developing cochlear
non-implanted ear.
ossification the implantation should be per-
2. Patients may refuse to use the HA in those cases
formed as soon as possible to achieve full
with poor HA performance.
insertion.
3. Use of the HA and CI together can reduce the
3. Those who want to restore binaural hearing or
need it in order to remain in their chosen performance achieved with the CI alone.
profession. 4. In cases with good HA performance, the results
4. Children with permanent bilateral profound obtained with the CI may be delayed. In these
hearing loss. Special attention should be paid patients it is recommended to stop using the
to young children who are in their speech and HA for a few weeks.
language acquisition periods.
Bimodal stimulation should be recommended in the
Both CIs should be fitted and balanced with following types of patient:
regard to volume in order to optimize the results.
In the case of two-stage surgery, it is sometimes 1. Those with residual hearing.
advisable to switch off the first implanted CI for a 2. Those with good HA performance in the non-
period of time in order to obtain stable CI perfor- implanted ear.
mance and fitting on the second side. In general, the 3. Those who want to restore binaural hearing.
fitting should aim to produce similar levels of 4. All young children, because it is difficult to
performance on each side. determine the hearing status of the non-
implanted ear.